Nonsurgical Rhinoplasty: A Systematic Review of Technique, Outcomes, and Complications

Overview

Filler injection into the nose is offered to patients who want a temporary result or wish to avoid surgery, and to correct irregularities after rhinoplasty. This systematic review assembled what has been published on filler types, injection technique, satisfaction and complications.

Sections of note

• Systematic review searching PubMed, EmBase, the Cochrane Library and Scopus using keyword and Medical Subject Headings terms.
• Data collected from each study covered satisfaction, complications, injection material, location and technique.
• 4,632 studies were found; after full-text screening, 23 were included.
• 1,600 patients underwent nonsurgical rhinoplasty across those studies.
• Materials used: hyaluronic acid in 73.38 percent, calcium hydroxyapatite in 12.44 percent.
• Nearly 95 percent of patients were satisfied with results.
• Only 26 relatively minor complications were reported, with no vascular complications such as skin necrosis or visual compromise; the authors state complications may be underreported.

What it means for a patient

• Across the published literature, satisfaction is high and reported complications are minor.
• No cases of skin death or blindness appeared in these 1,600 patients, but the authors explicitly warn that such events are likely underreported.
• Hyaluronic acid is the dominant material, which matters because it can be dissolved if a problem occurs.
• Limits: 23 studies of varying design, and published series are unlikely to capture rare catastrophic events.

Why this paper matters

Nasal filler's safety profile is contested because severe vascular complications are rare but devastating and case reports exist. This shows the published series do not capture them. The gap between case reports and series is itself the finding.

Terms

• Nonsurgical rhinoplasty: Reshaping the nose with injectable filler instead of surgery.
• Hyaluronic acid: A filler material that can be dissolved with an enzyme if needed.
• Calcium hydroxyapatite: A longer-lasting filler material that cannot be dissolved.
• Vascular compromise: Blood flow blocked or reduced in an area.
• Skin necrosis: Death of skin tissue from loss of blood supply.